Title: 2024 WIP-C Webinar 5
URL Source: blob://pdf/2fb29154-b4f4-4772-bdb2-5dea2127d5ea
Markdown Content:
Title 2 Protections and Medicare Coverage
2025 WIP-C TM Session 5
Work Incentive Support Center
Disability, Workplace, and Employment Support Practice Online Professional Programs 2
Information Screen
The Work Incentive Support Center (WISC) provides training, credentialing, and support to practitioners in the field of work incentive planning.
WISC is housed in the K. Lisa Yang and Hock E. Tan Institute on Employment and Disability. The institute, which is also known as the Yang-Tan Institute or YTI, is part of Cornell Universitys ILR School.
> Copyright 2025 Cornell ILR. All rights reserved. 3
## The WISC Team 4
## Todays Class
Work Activity Review and Medical Continuing Disability Review (CDR)
Medicare
Medicare basics
Medicare and work
2025 Medicare premiums
Medicare Part D Low Income Subsidy (LIS) 5
## Special Work Protection for People Who Get Title 2 Benefits
SSA provides additional work incentives for people who get Title 2 benefits beyond IRWEs and Special Conditions.
This includes Continuing Disability Review Protections, Work Activity Review Protections, and Extended Period of Medicare Coverage Protections. 6
## Work Activity Review and Medical CDR
Continuing disability reviews conducted by SSA 7
## SSA Reviews
SSA uses reviews to determine if people who get Title 2 benefits continue to be medically disabled and eligible for benefits payments.
Two types of reviews:
Work Activity Review
Medical Continuing Disability Review (CDR) 8
## Work Activity Review vs. Medical CDR
Work Activity Review
These decide what stage of the return-to-work process (TWP, RP, etc.) a worker has used and if a cessation or termination (with EXR possible in the future) should occur.
All work incentives still apply.
Can help avoid overpayments.
Medical CDR
These consider any changes in an individuals medical condition, and an unfavorable determination results in termination.
No work-related stages apply, including EXR. 9
## Triggering Work Activity Reviews
Generally, a Work Activity Review is triggered by the end of an event that may have improved the workers ability to work above the SGA level.
Examples of events that may trigger a Work Activity Review:
VR Re-examination case: When a person has completed a training/rehabilitation program.
Work-triggered: For a worker who gets Title 2 benefits, the end of the Trial Work Period (TWP). 10
## Scheduling Medical CDRs
A diary date is determined by disability severity and probability of improvement:
Medical Improvement Not Expected (MINE): CDR every 57 years
Medical Improvement Possible (MIP): CDR every 3 years
Medical Improvement Expected (MIE): CDR every 618 months 11
## The Medical CDR Questionnaire
In 70% of the cases due for review, SSA will send a questionnaire.
The questionnaire gathers information to answer these questions:
Has the person received medical treatment in the last 2 years?
Compared to 2 years ago, does the person feel better? Worse? The same?
In the past 2 years, has the person completed an educational program?
In the past 2 years, has the person worked?
Based on these answers, SSA will decide whether to conduct a full medical CDR. 12
## Ticket to Work CDR Protection
Using a Ticket requires that:
The Ticket must be assigned to an Employment Network (EN), or the individual must have an open case with the State VR agency, and
The individual is actively making progress in their approved plan.
The Program Manager (PM) determines if the individuals Ticket is in use. 13
## Ticket to Work CDR Protection (Cont.)
SSA cannot initiate a medical CDR if the individuals Ticket is in use.
However, if the Ticket is assigned after a medical CDR has begun, the medical CDR will be completed.
The Medical Improvement standard must be used. 14
## Other CDR Protection
If a person who gets Title 2 benefits has received 24 monthly payments, SSA is not allowed to initiate a CDR based on work activity alone after a Work Activity Review. 15
## Medicare
Knowing the rules, finding affordable options
Medicare basics
Medicare and work
2025 Medicare Costs
Medicare Part D Extra Help 16
## Medicare basics
Parts and waiting periods 17
## Parts of Medicare
Hospital Insurance/Part A:
Financed through FICA
Pays for inpatient hospital care and certain follow-up
Medical Insurance/Part B:
Pays for doctors services and various other medical services not covered under Part A
Voluntary and financed through monthly premiums paid by people opting for coverage ($185 if first enrolled after 1/1/25)
Medicare Advantage Program/Part C
Medicare Prescription Drug Plan/Part D 18
## Medicare Waiting Period
People who get SSDI benefits have a 24-month qualifying period for Medicare.
But if an individual has a primary or secondary diagnosis of ALS, this 24-month period is waived.
And if an individual has end-stage renal disease, they qualify for Medicare earlier than the 24 months.
The 24 months are cash-eligibility months:
They do not include the 5-month waiting period to receive SSDI benefits.
They do include RP months even if the worker is not receiving a monthly payment. 19
## Medicare and work
Important questions and rules 20
## Medicare Continues If Benefits Continue
If the SSDI payment continues, then Medicare continues.
When a person works at a non-SGA earnings level and payments continue, Medicare continues. This can last until age 65 when the individual then qualifies for Medicare based on age!
Be careful not to use EPMC rules when they are not applicable. 21
## Extended Period of Medicare Coverage (EPMC)
If SSDI payments stop due to SGA, Premium-Free Medicare Part A with premium Part B and D continues for at least 93 months following the TWP.
However, some people get more than 93 months of coverage, depending on when they perform SGA. 22
## More about EPMC
The generic advice is that the EPMC lasts at least 93 months after the TWP.
Because of the odd way the law was created, what happens as far as SGA in the first 16 months of the RP determines if the generic advice applies or the EPMC lasts even longer.
If you dont know what happened in the first 16 months, the generic advice always applies. If you know what happened in the first 16 months, you could give more specific advice. 23
## The Medicare Wizard
This online tool is designed to assist with determining when the EPMC will end due to work.
It includes a 16th-month analysis
medicarewizard.org 24
## Medicare after the EPMC
After the EPMC ends, workers may purchase Medicare Part A and B (known as SMI, or Standard Medical Insurance).
Workers may also purchase Part D.
Must be under age 65, continue to have a disabling condition, and have lost premium-free coverage due to work.
State-run programs can help pay Medicare costs.
The worker can take employer sponsored insurance. 25
## 2025 Medicare premiums
What coverage costs and how to afford it 26
## Part A Premiums after the EPMC
Based on the number of quarters of coverage on a workers record (or spouse).
In 2025, an individual will pay either $285 or $518 for Part A, in addition to Part B and D already being paid.
At this point, many workers can access employer insurance, ACA Marketplace Insurance, or Medicaid Buy-In. 27
## Cost of Medicare Part A in 2025
Monthly Premium = $0 for Medicare members
Deductible = $1,676 (per benefit period)
Coinsurance costs:
Days 160 = $0
Days 6190 = $419 per day
Days 91150 = $838 per daylifetime reserve days
After lifetime reserve days are used: 100% of all costs 28
## Cost of Medicare Part B in 2025
Monthly premium: Varies for those enrolled before 2017
Standard premium: $185 unless very high income
Deductible: $257
Coinsurance: 20% of Medicare allowed amount/fee schedule 29
## Cost of Medicare Part D in 2025
Monthly premium varies
Deductible of up to $590
75% coinsurance for most prescription drugs
Catastrophic Coverage: After $2,000 in out-of-pocket drug costs 30
## Medicare Savings Programs (MSPs)
Medicare Savings Programs (MSPs) are operated by the state and help pay Medicare costs for low-income individuals.
MSPs are administered through state Medicaid agencies.
The program are these:
Qualified Medicare Beneficiary (QMB): Medicare is basically free.
Specified Low-income Medicare Beneficiary (SLMB): Medicare Part B premium is covered.
Qualifying Individual (QI or QI-1): Medicare Part B premium is covered.
Qualified Disabled Working Individual (QDWI): Pays for Part A after EPMC ends. 31
## MSP Eligibility Calculator
Use Exhibit 4: Medicare Savings Plan Eligibility Worksheet to determine the workers eligibility.
Check your state rules on eligibility for each MSP category and edit the calculator, as needed, for your state.
Do separate calculations for when the consumer is getting a Title 2 payment and wages (through the end of the Grace Period), and for when Title 2 payments have stopped and the worker just has earned income. 32
## Medicaid and Medicare
Medicaid functions as a secondary insurance to Medicare Part A and B, which means it can pick up costs and services that Medicare does not.
Some Medicaid programs pay the Medicare Part B premium (check your state).
People who get Medicaid are automatically enrolled in Medicare Part D Low Income Subsidy (explained later). 33
## State Income and Asset Limits and Rules
States have wide latitude to determine what counts and what does not with these programs.
Some states have no asset limit.
Most states follow the SSI income and asset counting rules but there can be some variation.
These rules can usually be found in a states Medicaid rules or manual. 34
## Medicare Part D Low Income Subsidy (LIS)
Affording the Part D prescription drug plan 35
## Medicare Part D Assistance with Low Income Subsidy (LIS)
The LIS program was created because the Medicare cost structure is not affordable for low-income enrollees.
LIS is also referred to as Extra Help.
Individuals enrolled in Medicaid, QMB, SLMB, or QI-1 automatically qualify for this assistance.
Other individuals can apply through SSA or their state Medicaid agency.
Note
Some states also have State Pharmaceutical Assistance Programs that help with costs. 36
## Applying for LIS
Some individuals receive LIS through the application process.
Eligibility does not change with changes in income until the end of a calendar year.
LIS uses the SSI income counting methodology.
The application counts IRWEs at a set rate (16.3% for non-blind and 25% for blind). 37
## More about LIS
For efficiency, Medicare automatically enrolls Medicaid, QMB, SLMB, and QI individuals in LIS because a low-income determination has already been made.
If a person is on the rolls from JanuaryJune, LIS lasts the current year. If JulyDecember, it lasts the current year and the next year.
Planning is important. Changes may not occur until the end of the next calendar year! 38
## The Medicaid Buy-In Strategy
Most states have a Medicaid Buy-In Program for workers with disabilities (currently 45 states).
Enrollees in Medicaid Buy-In are automatically eligible for LIS.
Enrolling in this program for at least 1 month can be an effective strategy for maintaining LIS even at high levels of earnings! 39
## Review of Medicare Continuation
If Title 2 continues, Medicare continues.
If the individual works above SGA, premium-free Medicare Part A with premium Part B and D continues for at least 93 months (EPMC) after the TWP, or longer.
To determine if the individual keeps it longer, you need to know when SGA work was performed in the first 16 months of the Re-entitlement Period.
Use the Medicare Wizard to help determine when the EPMC ends if the generic rule does not apply.
After the EPMC, if the individual remains disabled, Medicare continues but there may be additional costs.
State programs may pay some costs, or the worker may want to elect private insurance. 40
## Medicare Conclusion
Medicare can continue when an individual works.
The costs associated with Medicare can be impacted by work.
Careful planning can ensure that a worker understands how to keep Medicare and use all available cost assistance. 41
## Summary of Title 2 Protections and Medicare Coverage
Every Title 2 person receives a medical CDR periodically.
Title 2 workers have a Work Activity Review to determine if their countable earnings are over SGA.
A medical CDR can be delayed while the worker is using their Ticket to Work and making progress to complete their work plan.
Medicare is an essential health benefit that can be maintained even after the worker has left the rolls.
There are many options to manage Medicare costs. 42
## Homework
Included in the Moodle platform
Covered at the beginning of the next class
Tip
Homework is neither corrected nor required, but it is a way to let your instructors know if anything is unclear. 43
## Contact Us
K. Lisa Yang and Hock E. Tan Institute on Employment and Disability
Cornell University
ILR School
201 Dolgen Hall
Ithaca, New York 14853
[email protected] Work Incentive Support Center Disability, Workplace, and Employment Support Practice Online Professional Programs